[1]李庆龙,吴爱悯,倪文飞,等.经皮椎体后凸成形术治疗骨质疏松性椎体骨折的常见并发症分析[J].中医正骨,2014,26(03):40-43.
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经皮椎体后凸成形术治疗骨质疏松性椎体骨折的常见并发 症分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第26卷
期数:
2014年03期
页码:
40-43
栏目:
脊柱微创技术
出版日期:
2014-03-30

文章信息/Info

作者:
李庆龙; 吴爱悯; 倪文飞; 黄其杉; 王向阳; 林焱; 毛方敏; 徐华梓; 池永龙
温州医科大学附属第二医院,浙江 温州 325027
关键词:
脊柱骨折 骨折; 压缩性 骨质疏松性骨折 椎体后凸成形术 手术后并发症
摘要:
目的:探讨经皮椎体后凸成形术治疗骨质疏松性椎体骨折的常见并发症及其对治疗效果的影响。方法:采用经皮椎体后凸成形术治疗骨质疏松性椎体骨折患者232例(266椎),T6骨折2椎、T7骨折10椎、T8骨折6椎、T9骨折7椎、T10骨折11椎、T11骨折27椎、T12骨折69椎、L1骨折82椎、L2骨折33椎、L3骨折12椎、L4骨折6椎、L5骨折1椎。术后严密观察患者生命体征,术后和随访时常规进行X线检查,观察骨水泥灌注及邻椎骨折发生情况。并于术后1周内进行伤椎CT薄层扫描及二维重建,按照倪文飞等的标准将骨水泥渗漏分为椎体周围渗漏、椎管内渗漏、椎间孔内渗漏、椎间隙渗漏、椎旁软组织内渗漏及混合型渗漏,分析椎间隙渗漏与邻椎骨折的关系。结果:①骨水泥渗漏情况。29椎发生骨水泥渗漏,T7渗漏1椎、T10渗漏1椎、T11渗漏3椎、T12渗漏9椎、L1渗漏11椎、L2渗漏4椎。椎体周围渗漏11椎、椎管内渗漏3椎、椎间孔内渗漏1椎、椎间隙渗漏7椎、椎旁软组织内渗漏2椎、混合型渗漏5椎(椎体周围渗漏合并椎管内渗漏2椎,椎体周围渗漏合并椎间隙渗漏3椎)。发生椎管内渗漏的3例患者出现胸背痛伴束带感等临床症状; 其中2例症状较重,急诊行椎板减压术治疗; 1例经非手术治疗后症状缓解。1例患者发生硬膜外血肿压迫脊髓,经非手术治疗后症状缓解。②邻椎骨折情况。术后7椎并发邻椎骨折,其中3椎有椎间隙渗漏; 11椎并发非邻椎骨折。并发骨水泥椎间隙渗漏椎体的邻椎骨折发生率高于未并发骨水泥椎间隙渗漏椎体(χ2=20.290,P=0.000)。③其他并发症。5例后期并发股骨颈骨折; 3例患者术后出现短暂呼吸费力,肺部CT未见明显骨水泥栓塞; 24例患者术后出现短暂性发热,体温均低于38.5 ℃,经对症处理后恢复正常。结论:骨水泥渗漏是经皮椎体后凸成形术的主要并发症,大多数骨水泥渗漏无需处理。椎管内渗漏和椎间孔渗漏可压迫脊髓和神经根,需急诊行椎板减压术治疗; 邻椎继发骨折可能与骨水泥椎间隙渗漏有关。

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备注/Memo

备注/Memo:
通讯作者:倪文飞 E-mail:niwenfei@126.com
更新日期/Last Update: 2014-03-20